Organization
INNOVATIVE ENDODONTICS NORTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E. LISIEN DMD (PRESIDENT)
(724) 940-3963
Entity
Organization
Contact information
Practice address
2593 WEXFORD BAYNE RD, SUITE 304, SEWICKLEY, PA 15143-8608
(724) 940-3963
(724) 940-3965
Mailing address
2593 WEXFORD BAYNE RD, SUITE 304, SEWICKLEY, PA 15143-8608
(724) 940-3963
(724) 940-3965
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DS037555
PA
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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